THE ANGELS WITH A BOX OF NEEDLES

The City's First Syringe Program Was Lucky To Survive
Its First Year, But It Is Still Saving Lives, Writes
Ruth Pollard.

TWENTY years ago a young doctor pinned up a handwritten note on the
door of a clinic at St Vincent's Hospital in Darlinghurst. It read:
"Free needles and syringes here".

At first demand was slow, but the clinic quickly ran out of the 1000
needles and syringes the staff had paid for themselves after passing
the hat around the office.

Outside, the newly discovered disease HIV was running rampant among
gay men, and there were two other groups desperately vulnerable to the
blood-borne virus - injecting drug users and sex workers.

Dr Alex Wodak, the director of alcohol and drug services at St
Vincent's, knew the most efficient way of transmitting the virus was
through sharing injecting equipment - infected blood, straight into
someone else's veins.

He and his team also knew that this cheap, simple public health
measure would take the means of transmission - the used needle and
syringe - out of the equation and stop the epidemic in its tracks.

However, the state government was nervous, as were the police. Health
officials were warning that distributing clean injecting equipment was
tantamount to condoning drug use.

Wodak and his colleagues went ahead anyway, risking the wrath of their
employers and the government, and possible arrest.

It was a gamble that paid off. By 2000, needle and syringe programs
around Australia had prevented an estimated 25,000 HIV infections and
21,000 hepatitis C infections and saved the country as much as $7.7
billion in health costs.

The Return on Investment study found that by 2010, 4500 deaths from
AIDS and 90 from hepatitis C will have been avoided.

However, as Wodak was led into a police interview room by a group of
detectives in November 1986, it was not clear that the fledgling
program would make it to the end of the year, let alone 20 years.

He had written 13 submissions to the Department of Health requesting
permission to establish a needle and syringe exchange program.

"When the last of these replies came back, I knew we were never going
to get official permission and that if it were to happen quickly, as
it needed to, it would only happen if somebody had the nerve to do
it," Wodak says.

His team collected statistics on people's age, their suburb, how many
needles and syringes they were given and how many they handed back.

What startled them was how many people had never had any contact with
a health service regarding their drug use. Very quickly Wodak's team
started referring drug users to treatment programs and other health
services.

"We only thought that this was going to be an HIV intervention but it
was much more than that," he says.

A detective sergeant in the drug squad in 1986, Frank Hansen was aware
that a needle and syringe program was operating illegally in
Darlinghurst. It presented police with a huge challenge, despite the
fact that senior officers had by then been convinced that the
provision of clean injecting equipment would prevent the spread of HIV
among drug users.

"It would be allowing people access to equipment with which they were
going to commit illegal acts," says Hansen, who is now head of the
drug and alcohol co-ordination unit of the state crime command.

"The police had an obligation to police that illegal activity and yet
in doing so accommodate this new and, at the time, quite controversial
project - it put operational police in a very difficult situation."

Gino Vumbaca was a 24-year-old social worker, fresh out of university,
when he joined the St Vincent's Hospital drug and alcohol service.

He says at that time injecting drug users were expected to hit "rock
bottom" before anyone, or any service, would help them. HIV turned all
that around.

"We knew there was an injecting drug user community around the area -
we had seen them on the street, using drugs, scoring drugs - and we
knew we could not just wait until HIV ran its course in this
population," says Vumbaca, who is now the executive officer of the
Australian National Council on Drugs.

The executive director of the NSW Users and AIDS Association, Michael
Lodge, says the program has opened the health system to injecting drug
users, who had experienced discrimination when trying to see doctors
and other health workers.

"It is vital that we are able to provide people with the means of
preventing HIV - it is really one of the great public health success
stories in modern medicine," he says.

Twenty years on, the model has been adopted throughout Australia, and
in NSW there are more than 860 needle and syringe programs, comprising
385 public sector services, 375 pharmacies and 108 syringe vending
machines.

There are also programs in every country in the European Union, and
they are now either in operation or being implemented around Asia,
often with the assistance of Australian aid money, Wodak says.

The US stands alone in its resistance to the program, he
says.

Consequently, the US has the highest AIDS incidence in the
industrialised world, and 36 per cent of new HIV cases are injecting
drug users, compared with less than 5 per cent in Australia.